Skillacquire

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Format:	On-Demand Webinar
Presenter:	Kelly S. Grahovac
Time:	You can access the webinar anytime
Duration:	60 minutes

The Affordable Care Act includes the 60-day overpayment rule, which requires suppliers to refund overpayments within 60 days of identification. What many suppliers aren’t aware of though is that if an overpayment is identified, either internally or externally, suppliers are mandated by law to perform a six-year lookback audit. This overly burdensome process has impacted hundreds of suppliers around the country and now that the TPE program has migrated to post payment reviews during the pandemic, this could impact even more suppliers. Even worse, if suppliers do not comply with this rule, they are at risk of false claim penalties. This panel will provide an overview of what is required of a supplier who is faced with an overpayment, how to manage the situation, what risks are associated with the overpayment rule and most importantly, how to mitigate your risk when dealing with this process. Lastly, the panel will provide real life case studies of suppliers who have experienced this challenge and the outcomes.

Learning Objectives

Identify situations in which the 60-day overpayment rule is applicable
Understand what steps a provider must take in the event of an overpayment
What can providers do to mitigate risk associated with the 60-day overpayment rule
Review the 60-day overpayment rule and the six-year lookback obligation
Know the steps that suppliers can take to reduce the risk of being subjected to the 60-day overpayment rule
Set out the steps the supplier should take to successfully fulfill its obligations under the rule

Areas Covered in the Session

Key Provisions
- Proactive compliance activities
- Investigative activities – RACs and UPICs
- Meaning of Identification
- Lookback Period
- How to report and return overpayments
- Identification of overpayments
Benchmark for Investigation
60-day to Refund
Six Year Look Back Period
No minimum monetary threshold
OIG Report
What OIG Found
What OIG Recommended
Sleep Management’s Response
Identify, Report, and Return
- Contractor Instructions
- OIG Recommend
- Timelines
Process
- Order
- Proof of delivery
- Refill request
- Continued need
- Appealed claim to MAC Redeterminations and QIC, if necessary
- Identify scope
- Claims data universe
- Sample sizes
- Determine audit components
- Analysis of findings
- Is there a loss to the government
- Identify overpayment
- Extrapolation
- Summary report
- Submit to MAC
Contractor Response
Outcomes
Impact
Medicaid Lookbacks
Concerns
UPIC Language
Federal Register
Final Rule
Legal Implications
Future Forecast
Prepare Your Practice
What if this happens to me

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Suggested Attendees

Revenue Cycle Team-coordinator of audit tracking
Billing Managers
Owners
Operations Staff Team
Compliance Officer
Physicians
Practice Managers
C-level executives
Medical billers
Medical Coders
Office staff and Billing Managers
Medical Billing Companies
Providers’ Office Staff
Hospital Revenue Cycle Staff

About the Presenter

Kelly Grahovac serves as the General Manager for The van Halem Group where she focuses on audits, appeals, education and training, and business development, in addition to management duties. Kelly is a known lecturer in the DME industry, speaking at national conferences, state associations, and for private events. Kelly came to The van Halem Group with 10 years of experience at one of the nation’s leading Medicare contractors where she worked for the Durable Medical Equipment Regional Carrier (DMERC), Qualified Independent Contractor (QIC), and A/B Medicare Administrative Contractor (MAC). Her various roles with Medicare include working as a senior provider relations representative, QIC Adjudicator and Training Specialist. Kelly has in-depth knowledge in Medicare appeals, policy, education, and training. Kelly is an active member of the Health Care Compliance Association (HCCA) and currently serves on the Medicare DME MAC Jurisdiction D Advisory Council, as well as the National Supplier Clearinghouse (NSC) Advisory Council. Kelly is also an active board member for the South Carolina Medical Equipment Suppliers Association (SCMESA). In addition to her client work at The van Halem Group, Kelly is also a contributor to several industry publications nationally.

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Course Content

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Webinar Link + Handouts PDF

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